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Not Clear on the Concept

Jennifer over at In Jennifer’s Head has a short post about her recent physical exam. In Did You Know she says,

That when you go in for that annual health screening so generously provided by your employer and they read your blood glucose at 54* that the nice little nurse lady will escort you to the fruit stand and make you eat a banana?

I think I would have told that nurse where to stick the banana. I’m always amazed at the number of people, including medical people who don’t get the concept here.

First, if Jennifer is not a diabetic, and she isn’t, why are they checking her blood glucose unless they suspect that she has developed Type II diabetes? If her mental status is normal, and having met and talked with her, I can assure you that it’s above normal, there isn’t any reason to check this. Well other than being “thorough” which more and more means seems to mean “Covering our asses.”

If you are screening for Type II Diabetes, that’s fine. However, Type II Diabetes typically has very high blood glucose readings, not low readings. Assuming that Jennifer was fasting and is not a Type I Diabetic, then a blood glucose of 54 is nothing to worry about because her body can release and use stored glucose in various forms to produce energy.

There no need for the nice little nurse lady to panic and insist that Jennifer eat a banana, drink orange juice, or do anything else to boost her glucose level. All Jennifer has to do is finish being examined and go out for breakfast (or lunch) like any other person would do when they get hungry.

Still this confusion persists at all levels of medicine. I wrote about it back in 2011. Neither medicine nor my opinions have changed since then, so I think it’s a good reference point.

I don’t know why people don’t get this. Maybe the answer is to do some “rebranding”. I know that both are caused with Insulin regulation problems, but how they are seen, evaluated, and treated are different, especially in the pre hospital setting. Rarely, well never, did I see a Type I Diabetic call because their blood glucose is too high. Rarely, but occasionally, I did see a Type II Diabetic who was hypoglycemic. The ones I did very sick, but still it was pretty rare. In no case did I ever find it necessary to provide ALS treatment to a person with a Diabetes history who was conscious and alert. At least not for the Diabetes.

It’s probably just me not having enough important subjects to write about, but it really does annoy me.

Comments

Actually, I think it’s just Dummercare. There is so much CYA, follow the protocol medicine, going on these days that it drives me crazy. Retiring has made it less obvious to me, but when I see it, I get angry. I could tell you about some of the ambulance reports I’ve reviewed lately, but it would only cause my head (and probably yours) to explode.

Any bets that Jennifer had been ‘instructed’ to fast for at least 12 hours before the exam? While that makes some other blood work more accurate, it does tend to throw off blood sugar…………….I agree that a lot of ‘medicine’ as it is currently practiced ain’t much better that witch doctoring or quackery, more about lessening liability than looking out for the whole person.

I would be very surprised if she hadn’t been since many doctor’s practice routinely test for cholesterol and that needs a fasting blood sample. Time and again I have to remind people, including doctors, that blood glucose correction is based on mental status, not a number.

I went to a meeting once (the only paramedic in a room full of nurses) where one of the speakers stopped and said “I need to sit down, I think I’m hypoglycemic.” She sat down and someone rushed over with –you guessed it– a Diet Coke. When no one else said anything, I perhaps-more-loudly-than-I-should-have suggested that she was not hypoaspartemic, and perhaps a glass of orange juice or non-diet soda might be more appropriate. Thankfully, she survived the episode.

The ordeal being the alleged treatment, not the diet coke, I assume. I can’t imagine you saying something even a bit more loudly than you should have. Seriously, I do have to wonder about the thought processes some people go through when they are at a medical emergency. Maybe it’s the effect of dumb medical shows like “House”.

A classic case of treating the machine and not the patient. A simple, “Hey, do you feel OK?” would have solved the problem. A BGL of 54 is pretty low; what are the odds the glucometer needed calibrating?

You are absolutely correct that there was no reason for it. She’s a cog in the machine. Once a year, they have a group come into the office to do wellness screenings. They check height, weight, waist circumference, blood pressure, cholesterol, and blood glucose. I was planning to grab my breakfast off the fruit stand anyway, so I didn’t roll my eyes too hard. Besides, I like bananas.
Yes, fasting.

For the record, it’s not that I am so smart. However, show me the same things enough times and eventually I’ll figure it out! It’s like the nice nurse educator at my primary care doctors office. She wanted to know if I wanted a glucometer so I could track my daily blood glucose levels. She seemed to think that it was very important even though it would do NOTHING to improve my health. OTOH, my doctor told me that getting an A1C every 3-4 months would be sufficient. I went with is advice.

I don’t like bananas, because they remind me of dentists. That would take a blog post to explain and I don’t know that anyone would stay awake through all of it.

My favorite is the instant assumption that because ONE lab result came back out of the normal range, that the patient (me) must have a chronic condition. . . despite having several years of regular blood work results that indicate nothing abnormal at all.

Like the ONE time my cholesterol results came back high, and they immediately prescribed the cool new drug (I forget if it was Crestor or lipitor — all I know is it tore my lower colon UP, so I flushed the pills. . . ). Despite my terminating treatment, all my follow up labs indicated normal (albeit high normal) results. . .

Or the ONE time I had a ridiculously high blood sugar reading on a fasting blood test. Only I had a new doctor, and she just asked if I fasted (yes, becuaus i look at early morning blood draws as a “valid” an excuse to hit McDonald’s afterwards for a Bacon, Egg, and Cheese biscuit on the way to work {grin}). Then she said, “Well, it could be a contaminated lab sample or some other techinical error, so here’s a free glucose meter and test strips.” So, I took the finger stabby thingie home and tested myself at specific intervals during the day, exactly as ordered, only to establish that in 60 days, my blood sugar NEVER varied outside expected norms. Doc’s response? “OK, now we’ve proven it was bad labs.”

I like my doc. No drama, no focusing on zebra hunts (although if there’s a relatively easy and cheap way to eliminate a zebra, she does), and she LISTENS TO ME and ACTUALLY USES WHAT I TELL HER ABOUT WHAT MY BODY IS TELLING ME. (LIke when I asked for a refill on the 72 hour pain meds the urgent care center gave me after I broke my hand, she contacted the hand specialist I was scheduled to see the next day and told him to expect more damage than the doc-in-the-box report indicated. . . because she knows I HATE mind altering meds and am irrationally terrified of addictive ones. If _I_ was asking for narcotics, it meant I was in a LOT of pain.)

All About Me

After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it?
I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs.
I still write about EMS, but I'm adding more and more non EMS subject matter.
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